Is Integrative Medicine Covered by Insurance?

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Is integrative medicine covered by insurance? The answer is, sometimes. Although many integrative medicine therapies are covered under the Affordable Care Act (ACA), there are a number of holistic approaches not included under any insurance plan. Still, there are steps you can take to help you get the treatment you need.

What is integrative medicine?

Integrative medicine is part of a holistic approach to wellbeing. Often included in the spectrum of complementary or alternative medicine, integrative medicine combines traditional Western medical treatments like surgery and medication with complementary treatments like massage, acupuncture, and chiropractic. 

Common types of integrative medicine include:

• Chiropractic care
• Acupuncture
• Mind-body therapies like yoga, meditation, and tai chi
• Massage therapy
• Behavioral therapy
• Diet and nutrition counseling

Is integrative medicine covered by insurance?

Some integrative treatments are covered by insurance. However, most health insurance plans only partially cover complementary and integrative therapies — typically those they consider medically necessary.

General coverage

In most cases, insurance companies offer partial or no coverage for complementary and integrative medicine treatments. Private health insurance, as well as public health insurance programs offer coverage for treatment approaches that are well supported by evidence-based studies, such as chiropractic care. 

While there is an abundance of peer-reviewed research emerging about various complementary and integrative therapies, many insurance companies have not yet reviewed the material and approved treatments. 

Affordable Care Act and other public programs

The Affordable Care Act (ACA), enacted in 2010, covers some forms of integrative medicine. However, the ACA only covers treatments that are widely accepted as effective, have scientific backing, and are considered medically necessary.

For example, the ACA covers diet and nutritional counseling to monitor and manage chronic health conditions like diabetes, endometriosis, and polycystic ovary syndrome (also called polycystic ovarian syndrome or PCOS). 

The ACA also offers mental health and substance abuse treatment coverage, including counseling to help you cope with stress and pain caused by chronic menstrual health issues. 

Medicare and Medicaid are complex forms of healthcare, and their coverage options vary by state and program. For example, according to Medicare.gov, Medicare Part B covers medically necessary chiropractic spinal manipulation to correct a subluxation, but it does not cover acupuncture or massage therapy for the same injury.

Unlike Medicare, Medicaid is administered at the state level, which affects the types of integrative treatments covered. Each state’s Medicaid coverage options vary, so it’s important to check with your state to determine which types of integrative treatments are included in your policy. 

Partial coverage for popular complementary and integrative treatments

Beside nutrition and behavioral therapy, the most commonly covered integrative medicine approaches are chiropractic care, acupuncture, and massage. In an aggregate study of ten National Health Interview Surveys from 2002 to 2012, 60% of Americans had some coverage for chiropractic treatment. 

Coverage rates for acupuncture and massage were much lower, at only 25% and 15%, respectively. Integrative medicine coverage rates have likely increased since the aggregate survey was concluded, albeit to a limited extent.

The same study reports that most people seeking integrative treatment only had partial coverage. Only around 18.7% of people had complete coverage for chiropractic care, whereas 41.4% had partial coverage, and 39.9% had no coverage. 

Acupuncture only saw 16.5% with partial coverage and 75% with no coverage, while 84.7% had no coverage for massage services and 8.3% had partial coverage. 

How to find out if you have integrative medicine coverage

The best way to determine if you have insurance coverage for a specific complementary or integrative therapy is to contact your insurance provider. Have your summary of benefits and coverage handy when you call your insurer. 

Summary of benefits and coverage (SBC)

Contact your healthcare provider and ask for a Summary of Benefits and Coverage (SBC). Every health insurance company must provide you with your SBC, whether you are insured through the ACA, Medicare or Medicaid, or a private carrier. 

The SBC should contain an easily readable summary of your benefits under the plan and a glossary of important terms. The document will also give you a few examples of coverage in action to help you understand your benefits. 

Before speaking to a representative, it’s a good idea to read this document to understand what your insurance might cover. 

Speak with your insurance provider

Unless your SBC clearly outlines your coverage for the integrative therapy you’re considering, you’ll need to speak with your insurance provider directly. This can clarify all your questions regarding your coverage for integrative treatment options and allow you to keep records of these conversations for future reference. 

When speaking with your insurance provider, ask the following questions to get specific information about your coverage so you aren’t surprised by a claim denial: 

• Is this integrative approach covered for my health condition? 
• Do I need a prescription or referral from a primary care provider?
• Does this treatment require pre-approval or preauthorization? Are there any conditions that need to be met for coverage?
• What integrative providers can I visit? Can I choose my own, or does my insurance offer in-network options?
• How many visits are covered?
• Is there a monetary cap on my visits to this provider?
• Do I need to meet a deductible before the treatment is covered?
• What are my out-of-pocket expenses for this treatment?

Be sure to make a record of your phone call. Take detailed notes or record the call if possible. Also, keep a copy of any correspondence you receive after an integrative treatment session as well as copies of your claim forms and bills. You may need these documents later if you run into a claims dispute. 

Additional insurance options

If you discover your insurance provider doesn’t cover an alternative medicine approach you need, you may have options. 

Employer-sponsored programs

Your employer may offer an employee well-being program that helps cover the cost of complementary treatments. Well-being programs often help with diet and nutrition, mental health, and other areas of well-being for employees. Check to see if your employer offers such a program and if it is an option for integrative treatment for your condition. 

Evidence-based reports

Insurance companies disregard many complementary and integrative therapies due to a lack of evidence-based research proving the effectiveness of the treatments. To help get coverage, you can collect scientific, peer-reviewed research supporting integrative treatments that are effective for your condition. 

You can find these studies on PubMed or through the National Center for Complementary and Integrative Health (NCCIH). 

Appeal denied claims

If you get complementary therapy after speaking with your insurance company but your claim is denied, you have the right to appeal. First, speak with your insurance company and integrative practitioner to be sure the denial wasn’t due to a coding error. Then, request a review from the insurance provider. 

If nothing comes of a review, follow the insurance company’s appeal process to appeal the claim. According to the United States Government Accountability Office, 39% to 59% of patients who appeal a claims denial win their case.

Paying out of pocket

If you seek integrative medicine therapy for conditions such as PCOS or endometriosis, you may have to pay out of pocket. Americans spend an estimated $14.7 billion in out-of-pocket costs for complementary therapies each year. 

If you pay out of pocket for treatment, such as pelvic floor therapy, acupuncture, or a form of traditional Chinese medicine, there are a few actions you can take to ensure you can afford the treatment you need. 

Payment plans

When you search for integrative therapists, ask about any payment plans they may offer. Payment plans break down costs into manageable weekly or monthly payments. Ask if they accept credit cards, which can help you pay off your treatment gradually. 

Sliding-scale fees

Some integrative medicine practitioners offer sliding-scale fees to their patients. Sliding-scale fees use an income-based method to determine a fair amount for you to pay for treatment. 

Health savings accounts and flexible spending accounts

If you have an HSA or FSA, you may be able to use it to pay for your treatment. Integrative therapies that may be eligible for coverage include nutrition counseling, behavioral therapy, acupuncture, chiropractic, massage, herbal medicine, hypnotherapy, naturopathic medicine, and others. 

In many cases, you will need a letter of medical necessity from your healthcare provider, so check with your insurance carrier before booking an appointment.  

Check with your insurance company and integrative provider

Health insurance coverage varies based on several factors. While many health insurance companies offer partial coverage for complementary and integrative therapies, most integrative treatments are not covered. Always check with your insurance company and your integrative medicine therapy provider to determine your specific level of coverage. 

Find a complementary or integrative therapist near you with Sound Cycle’s network of qualified and vetted practitioners.